public void InsPlan_GetInsUsedDisplay_OrthoProcsNotAffectInsUsed() { string suffix = "13"; Patient pat = PatientT.CreatePatient(suffix); Carrier carrier = CarrierT.CreateCarrier(suffix); InsPlan plan = InsPlanT.CreateInsPlan(carrier.CarrierNum); InsSub sub = InsSubT.CreateInsSub(pat.PatNum, plan.PlanNum); long subNum = sub.InsSubNum; PatPlan patPlan = PatPlanT.CreatePatPlan(1, pat.PatNum, subNum); BenefitT.CreateAnnualMax(plan.PlanNum, 100); BenefitT.CreateOrthoMax(plan.PlanNum, 500); BenefitT.CreateCategoryPercent(plan.PlanNum, EbenefitCategory.Diagnostic, 100); BenefitT.CreateCategoryPercent(plan.PlanNum, EbenefitCategory.Orthodontics, 100); Procedure proc1 = ProcedureT.CreateProcedure(pat, "D0140", ProcStat.C, "", 59); //limEx Procedure proc2 = ProcedureT.CreateProcedure(pat, "D8090", ProcStat.C, "", 348); //Comprehensive ortho ClaimProcT.AddInsPaid(pat.PatNum, plan.PlanNum, proc1.ProcNum, 59, subNum, 0, 0); ClaimProcT.AddInsPaid(pat.PatNum, plan.PlanNum, proc2.ProcNum, 348, subNum, 0, 0); //Lists Family fam = Patients.GetFamily(pat.PatNum); List <InsSub> subList = InsSubs.RefreshForFam(fam); List <InsPlan> planList = InsPlans.RefreshForSubList(subList); List <PatPlan> patPlans = PatPlans.Refresh(pat.PatNum); List <Benefit> benefitList = Benefits.Refresh(patPlans, subList); List <ClaimProcHist> histList = ClaimProcs.GetHistList(pat.PatNum, benefitList, patPlans, planList, DateTime.Today, subList); //Validate double insUsed = InsPlans.GetInsUsedDisplay(histList, DateTime.Today, plan.PlanNum, patPlan.PatPlanNum, -1, planList, benefitList, pat.PatNum, subNum); Assert.AreEqual(59, insUsed); }
public void InsPlan_GetPendingDisplay_LimitationsOverrideGeneralLimitations() { string suffix = "31"; Patient pat = PatientT.CreatePatient(suffix); long patNum = pat.PatNum; Carrier carrier = CarrierT.CreateCarrier(suffix); InsPlan plan = InsPlanT.CreateInsPlan(carrier.CarrierNum); long planNum = plan.PlanNum; InsSub sub = InsSubT.CreateInsSub(pat.PatNum, planNum); //guarantor is subscriber long subNum = sub.InsSubNum; long patPlanNum = PatPlanT.CreatePatPlan(1, pat.PatNum, subNum).PatPlanNum; BenefitT.CreateAnnualMax(planNum, 1000); BenefitT.CreateCategoryPercent(planNum, EbenefitCategory.RoutinePreventive, 100); BenefitT.CreateLimitation(planNum, EbenefitCategory.RoutinePreventive, 1000); //Changing this amount would affect patient portion vs ins portion. But regardless of the amount, this should prevent any pending from showing in the box, which is for general pending only. Procedure proc = ProcedureT.CreateProcedure(pat, "D1110", ProcStat.C, "", 125); //Prophy //Lists List <ClaimProc> claimProcs = ClaimProcs.Refresh(pat.PatNum); Family fam = Patients.GetFamily(patNum); List <InsSub> subList = InsSubs.RefreshForFam(fam); List <InsPlan> planList = InsPlans.RefreshForSubList(subList); List <PatPlan> patPlans = PatPlans.Refresh(patNum); List <Benefit> benefitList = Benefits.Refresh(patPlans, subList); List <Procedure> ProcList = Procedures.Refresh(pat.PatNum); Claim claim = ClaimT.CreateClaim("P", patPlans, planList, claimProcs, ProcList, pat, ProcList, benefitList, subList);//Creates the claim in the same manner as the account module, including estimates and status NotReceived. List <ClaimProcHist> histList = ClaimProcs.GetHistList(patNum, benefitList, patPlans, planList, DateTime.Today, subList); //Validate Assert.AreEqual(0, InsPlans.GetPendingDisplay(histList, DateTime.Today, plan, patPlanNum, -1, patNum, subNum, benefitList)); }
public void InsPlan_GetInsUsedDisplay_LimitationsOverride() { string suffix = "6"; Patient pat = PatientT.CreatePatient(suffix); long patNum = pat.PatNum; Carrier carrier = CarrierT.CreateCarrier(suffix); InsPlan plan = InsPlanT.CreateInsPlan(carrier.CarrierNum); long planNum = plan.PlanNum; InsSub sub = InsSubT.CreateInsSub(pat.PatNum, planNum); //guarantor is subscriber long subNum = sub.InsSubNum; long patPlanNum = PatPlanT.CreatePatPlan(1, pat.PatNum, subNum).PatPlanNum; BenefitT.CreateAnnualMax(planNum, 1000); BenefitT.CreateLimitation(planNum, EbenefitCategory.Diagnostic, 1000); Procedure proc = ProcedureT.CreateProcedure(pat, "D0120", ProcStat.C, "", 50); //An exam long procNum = proc.ProcNum; Procedure proc2 = ProcedureT.CreateProcedure(pat, "D2750", ProcStat.C, "8", 830); //create a crown ClaimProcT.AddInsPaid(patNum, planNum, procNum, 50, subNum, 0, 0); ClaimProcT.AddInsPaid(patNum, planNum, proc2.ProcNum, 400, subNum, 0, 0); //Lists Family fam = Patients.GetFamily(patNum); List <InsSub> subList = InsSubs.RefreshForFam(fam); List <InsPlan> planList = InsPlans.RefreshForSubList(subList); List <PatPlan> patPlans = PatPlans.Refresh(patNum); List <Benefit> benefitList = Benefits.Refresh(patPlans, subList); List <ClaimProcHist> histList = ClaimProcs.GetHistList(patNum, benefitList, patPlans, planList, DateTime.Today, subList); //Validate double insUsed = InsPlans.GetInsUsedDisplay(histList, DateTime.Today, planNum, patPlanNum, -1, planList, benefitList, patNum, subNum); Assert.AreEqual(400, insUsed); }
public void Claims_CalculateAndUpdate_PreauthOrderWriteoff() { string suffix = MethodBase.GetCurrentMethod().Name; //create the patient and insurance information Patient pat = PatientT.CreatePatient(suffix); //proc - Crown Procedure proc = ProcedureT.CreateProcedure(pat, "D2750", ProcStat.C, "8", 1000); long feeSchedNum1 = FeeSchedT.CreateFeeSched(FeeScheduleType.Normal, suffix); FeeT.CreateFee(feeSchedNum1, proc.CodeNum, 900); Carrier carrier = CarrierT.CreateCarrier(suffix); InsPlan insPlan = InsPlanT.CreateInsPlanPPO(carrier.CarrierNum, feeSchedNum1); BenefitT.CreateAnnualMax(insPlan.PlanNum, 1000); BenefitT.CreateCategoryPercent(insPlan.PlanNum, EbenefitCategory.Crowns, 100); InsSub sub = InsSubT.CreateInsSub(pat.PatNum, insPlan.PlanNum); PatPlan pp = PatPlanT.CreatePatPlan(1, pat.PatNum, sub.InsSubNum); //create lists and variables required for ComputeEstimates() List <InsSub> SubList = InsSubs.RefreshForFam(Patients.GetFamily(pat.PatNum)); List <InsPlan> listInsPlan = InsPlans.RefreshForSubList(SubList); List <PatPlan> listPatPlan = PatPlans.Refresh(pat.PatNum); List <Benefit> listBenefits = Benefits.Refresh(listPatPlan, SubList); List <Procedure> listProcsForPat = Procedures.Refresh(pat.PatNum); List <Procedure> procsForClaim = new List <Procedure>(); procsForClaim.Add(proc); //Create the claim and associated claimprocs //The order of these claimprocs is the whole point of the unit test. //Create Preauth ClaimProcs.CreateEst(new ClaimProc(), proc, insPlan, sub, 0, 500, true, true); //Create Estimate ClaimProcs.CreateEst(new ClaimProc(), proc, insPlan, sub, 1000, 1000, true, false); List <ClaimProc> listClaimProcs = ClaimProcs.Refresh(pat.PatNum); Claim claimWaiting = ClaimT.CreateClaim("W", listPatPlan, listInsPlan, listClaimProcs, listProcsForPat, pat, procsForClaim, listBenefits, SubList, false); Assert.AreEqual(100, claimWaiting.WriteOff, "WriteOff Amount"); }
public void Claims_CalculateAndUpdate_Allowed1Allowed2CompletedProcedures() { string suffix = "8"; Patient pat = PatientT.CreatePatient(suffix); long patNum = pat.PatNum; long feeSchedNum1 = FeeSchedT.CreateFeeSched(FeeScheduleType.Normal, suffix); long feeSchedNum2 = FeeSchedT.CreateFeeSched(FeeScheduleType.Normal, suffix + "b"); //Standard Fee long codeNum = ProcedureCodes.GetCodeNum("D2750"); Fee fee = Fees.GetFee(codeNum, 53, 0, 0); if (fee == null) { fee = new Fee(); fee.CodeNum = codeNum; fee.FeeSched = 53; fee.Amount = 1200; Fees.Insert(fee); } else { fee.Amount = 1200; Fees.Update(fee); } //PPO fees fee = new Fee(); fee.CodeNum = codeNum; fee.FeeSched = feeSchedNum1; fee.Amount = 600; Fees.Insert(fee); fee = new Fee(); fee.CodeNum = codeNum; fee.FeeSched = feeSchedNum2; fee.Amount = 800; Fees.Insert(fee); //Carrier Carrier carrier = CarrierT.CreateCarrier(suffix); long planNum1 = InsPlanT.CreateInsPlanPPO(carrier.CarrierNum, feeSchedNum1).PlanNum; long planNum2 = InsPlanT.CreateInsPlanPPO(carrier.CarrierNum, feeSchedNum2).PlanNum; InsSub sub1 = InsSubT.CreateInsSub(pat.PatNum, planNum1); long subNum1 = sub1.InsSubNum; InsSub sub2 = InsSubT.CreateInsSub(pat.PatNum, planNum2); long subNum2 = sub2.InsSubNum; BenefitT.CreateCategoryPercent(planNum1, EbenefitCategory.Crowns, 50); BenefitT.CreateCategoryPercent(planNum2, EbenefitCategory.Crowns, 50); BenefitT.CreateAnnualMax(planNum1, 1000); BenefitT.CreateAnnualMax(planNum2, 1000); PatPlanT.CreatePatPlan(1, patNum, subNum1); PatPlanT.CreatePatPlan(2, patNum, subNum2); Procedure proc = ProcedureT.CreateProcedure(pat, "D2750", ProcStat.TP, "8", Fees.GetAmount0(codeNum, 53)); //crown on 8 long procNum = proc.ProcNum; //Lists List <ClaimProc> claimProcs = ClaimProcs.Refresh(patNum); Family fam = Patients.GetFamily(patNum); List <InsSub> subList = InsSubs.RefreshForFam(fam); List <InsPlan> planList = InsPlans.RefreshForSubList(subList); List <PatPlan> patPlans = PatPlans.Refresh(patNum); List <Benefit> benefitList = Benefits.Refresh(patPlans, subList); List <Procedure> procList = Procedures.Refresh(patNum); //Set complete and attach to claim ProcedureT.SetComplete(proc, pat, planList, patPlans, claimProcs, benefitList, subList); claimProcs = ClaimProcs.Refresh(patNum); List <Procedure> procsForClaim = new List <Procedure>(); procsForClaim.Add(proc); Claim claim = ClaimT.CreateClaim("P", patPlans, planList, claimProcs, procList, pat, procsForClaim, benefitList, subList); //Validate Assert.AreEqual(500, claim.WriteOff); }